Pulmonary Artery Catheterization

PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION

(Swan-Ganz)(Swan-Ganz)


I. Indications:I. Indications:a. Diagnosis and evaluation of heart a. Diagnosis and evaluation of heart

disease.disease.

b. Evaluates patient’s response to b. Evaluates patient’s response to

treatment.treatment.

c. Simultaneous assessment of c. Simultaneous assessment of severalseveral

hemodynamic parameters.hemodynamic parameters.


Pulmonary Artery Pressure (PAP)Pulmonary Artery Pressure (PAP) Pulmonary Capillary Wedge Pressure Pulmonary Capillary Wedge Pressure

(PCWP)(PCWP) Cardiac Output / Cardiac Index (CO / Cardiac Output / Cardiac Index (CO /

CI)CI) Mixed Venous Oxygen Saturation Mixed Venous Oxygen Saturation

(SVO2)(SVO2)


II. PA CathetersII. PA Catheters 4 Lumen catheters4 Lumen catheters

a.a. Proximal lumenProximal lumen - IV infusion, - IV infusion, (blue)(blue) CVP CVP measurement, measurement, venous blood venous blood samples, samples, injection of injection of fluids.fluids.


II. PA CathetersII. PA Catheters 4 Lumen catheters4 Lumen catheters

b. Distal lumenb. Distal lumen - PA pressures - PA pressures

(yellow)(yellow)

c. Balloon inflation lumen (red)c. Balloon inflation lumen (red)

d. Thermistor lumen - cardiacd. Thermistor lumen - cardiac

outputoutput


II. PA CathetersII. PA Catheters

Others: Multi-lumen PA cathetersOthers: Multi-lumen PA catheters • 5 lumen - • 5 lumen -

fiberoptic lumenfiberoptic lumen• • 7 lumen - pacemaker lumen; 7 lumen - pacemaker lumen; injectate injectate lumenlumen


III. Sites of III. Sites of insertioninsertion

• • Subclavian Subclavian VeinVein

Jugular VeinJugular Vein

Brachial VeinBrachial Vein

Femoral VeinFemoral Vein


IV. Things to prepare:IV. Things to prepare: adhesive tapesadhesive tapes amplifier/ recorderamplifier/ recorder betadinebetadine cordis sheathcordis sheath critiflo/ intraflocritiflo/ intraflo DD55NSS w/ HeparinNSS w/ Heparin DD55NSS (plain)NSS (plain) glovesgloves

infusion set tubinginfusion set tubing multiple lumen cathetermultiple lumen catheter OS 4x4OS 4x4 pressure bagpressure bag Seldinger/Cook’s Seldinger/Cook’s

needleneedle 3-way stopcock3-way stopcock 10 cc syringes (2)10 cc syringes (2) transducertransducer


V. Nursing ResponsibilitiesV. Nursing Responsibilities

A. Before InsertionA. Before Insertion

1. Explain procedure 1. Explain procedure

2. Informed written 2. Informed written consent.consent.




3. Assemble equipment / 3. Assemble equipment / suppliessupplies

4. Measure BP, PR and RR;4. Measure BP, PR and RR;

Temperature (CO)Temperature (CO)




5. Attach to ECG monitor.5. Attach to ECG monitor.

6. Position: Supine or 6. Position: Supine or

TrendelenbergTrendelenberg



B. During InsertionB. During Insertion

1. Monitor the patient’s 1. Monitor the patient’s ECG.ECG.

2. Stay with the patient.2. Stay with the patient.

PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATIONC. After insertionC. After insertion

1. Observe for signs of 1. Observe for signs of

pneumothorax.pneumothorax.

2. Continuous monitoring of chest 2. Continuous monitoring of chest sounds / ECG sounds / ECG


Right Atrial Pressure Right Atrial Pressure (RAP)(RAP)

- 2 - 6 mmHg- 2 - 6 mmHg Increased PressureIncreased Pressure

volume overload; Right volume overload; Right heart failure; heart failure; Pulmonary HpnPulmonary Hpn

Decreased PressureDecreased Pressure hypovolemiahypovolemia


Right Ventricular Pressure Right Ventricular Pressure (RVP)(RVP)

15 - 25 mmHg15 - 25 mmHg

2 - 8 mmHg2 - 8 mmHg

Increased PressureIncreased Pressure Pulmonary diseases; Pulmonary diseases;

Septal DefectsSeptal Defects


Pulmonary Artery Pulmonary Artery PressurePressure

15 - 25 mmHg15 - 25 mmHg

8 - 15 mmHg8 - 15 mmHg

Increased PressureIncreased Pressure left heart failureleft heart failure Pulmonary Pulmonary

edema/embolismedema/embolism


Pulmonary Capillary Wedge Pulmonary Capillary Wedge Pressure ( PCWP)Pressure ( PCWP)

4 - 12 mmHg (mean)4 - 12 mmHg (mean)

Increased PressureIncreased Pressure Left Heart FailureLeft Heart Failure Pericardial TamponadePericardial Tamponade Reduced CO2Reduced CO2

PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATIONC. After insertionC. After insertion

3. Check for signs of 3. Check for signs of decreaseddecreased

circulation.circulation.

4. Check for signs of infection.4. Check for signs of infection.


C. After insertionC. After insertion

5. Document all pressure 5. Document all pressure readingsreadings

including patient’s including patient’s position.position.

6. Troubleshoot 6. Troubleshoot hemodynamic hemodynamic monitoring problems monitoring problemsPROBLEM CAUSES TROUBLESHOOTING

a. Damping ofwaveform / No tracing

Air bubbles / blood /blood clots along theline

Loose connections /disconnections

Kinked catheter Incorrect position of

stopcocks Improper adjustment

of sensitivity control

- complete flushingbefore insertion

- aspirate / never flushair / clot

- check patency oftubings.

- adjust sensitivity- Recalibrate

6. Troubleshoot 6. Troubleshoot hemodynamic hemodynamic monitoring problems monitoring problems

b. Failure to wedge Balloon rupture - NEVER inflateballoon

- Indicate balloon isruptured. “ NoWedging”

PROBLEM CAUSES TROUBLESHOOTING

6. Troubleshoot 6. Troubleshoot hemodynamic hemodynamic monitoring problems monitoring problemsPROBLEM CAUSES TROUBLESHOOTING

c. Permanent Wedging

Balloon inadvertentlyinflated

Catheter migration

- ensure catheterdeflation

- turn patient from sideto side

- deep breathing andvoluntary coughing

- refer to doctor


C. After insertionC. After insertion

7. Administer oxygen 7. Administer oxygen therapy andtherapy and

medications as ordered.medications as ordered.


8. Watch out for complications.8. Watch out for complications.

1. Dysrrhythmias1. Dysrrhythmias-- irritation ofirritation of

heart musclesheart muscles

2. Local infection2. Local infection -- irritation; poorirritation; poor

sterile sterile

techniquestechniques

3. Pulmonary Artery Perforation3. Pulmonary Artery Perforation

-- over-inflationover-inflation



4. Pulmonary Infarction 4. Pulmonary Infarction

- frequent prolonged wedging- frequent prolonged wedging

- thrombus formation- thrombus formation

5. Pulmonary Embolism5. Pulmonary Embolism

- over / frequent inflation; air - over / frequent inflation; air embolism embolism



6. Endocarditis - mechanical irritation; 6. Endocarditis - mechanical irritation;

bacterial growthbacterial growth

7. Knotting of Catheter - continuous7. Knotting of Catheter - continuous

manipulationmanipulation

8. Pneumothorax - insertion techniques8. Pneumothorax - insertion techniques


VI. Responsibilities during removal of VI. Responsibilities during removal of PA linePA line

1. Lidocaine bolus and defibrillation at1. Lidocaine bolus and defibrillation at

bedsidebedside

2. Obtain vital signs2. Obtain vital signs

3. Assess circulation of extremities3. Assess circulation of extremities

4. Deflate balloon 4. Deflate balloon


VI. Responsibilities during removal of PA VI. Responsibilities during removal of PA lineline

5. Monitor for dysrrhythmias5. Monitor for dysrrhythmias

6. Apply firm pressure until bleeding 6. Apply firm pressure until bleeding stops.stops.

7. Apply betadine and dressing7. Apply betadine and dressing

NOTE: PA Catheter to stay for 72 hours.NOTE: PA Catheter to stay for 72 hours.

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Pulmonary Artery Catheterization